Exam 2: Pulmonary Flashcards
How many lobes are in the right lung?
3
How many lobes are in the left lung?
2
Where is lung apices located?
2-4cm above the clavicle
Where does the trachea bifurcate into R and L bronci?
Anteriorly- sternal angle
Posteriorly- T4
What is the normal respiration rate?
14-20 breaths/min
What is it called when the diaphragm contracts, chest wall expands, and negative intrathoracic pressure draws
air into lungs?
Inspiration
What is it called when the diaphragm relaxes, chest wall contracts, intrathoracic pressure normalizes, air leaves lungs?
Expiration
What is the order of techniques?
IPPA Inspection Palpation Percussion Auscultation
What are common causes of tracheal deviation?
Large pleural effusion, large pneumothorax, mass/tumor
What is pectus carinatum?
Convex anterior chest
What is pactus excavatum?
Concave anterior chest
What is barrel chest?
Increased A-P diameter
What is flail chest?
Rib fractures cause paradoxical movement of chest wall
What is kyphosis?
Abnormal forward curvature of spine
What is scoliosis?
Abnormal lateral curvature of the spine
What is bradypnea? What are some causes?
Slow respirations
<12 breaths/min
-Diabetic coma, drug induced respiratory depression
What is tachypnea? What are some causes?
Rapid respirations
>20 breaths/min
-Restrictive lung disease, elevated diaphragm, pain
What is hyperventilation?
Faster, deeper respiration
What is sighing?
Periodic deeper breaths
What is obstructive breathing?
Prolonged expiration
2/2 increased airway resistance
What would you call rapid and deep respiration
caused by metabolic acidosis?
Kassmaul breathing
What would you call irregular, unpredictable, shallow or deep, with intermittent apnea?
Biot’s breathing
What would you call periods of gradually increasing and decreasing depth of respirations
with periods of apnea?
Cheyne-Strokes breathing
What would you call the absence of spontaneous respiration?
Apnea
What would you call crackling/grating feeling or sound?
Crepitus
A patient presents with air from lung/chest tracts along tissue planes, swelling of eyelids, cheeks, lips, neck, and chest. What do you suspect?
Subcutaneous Emphysema
What can cause decreased fremitus?
Obstructed bronchus COPD Pleural effusion Lung fibrosis Pneumothorax
What can cause increased fremitus?
Pneumonia/consolidation
How many levels of percussion and auscultation should you do anteriorly, posteriorly, and laterally?
Anterior- 3
Posterior- 4
Lateral- 1
What is the purpose of percussion?
Determine if underlying tissue are air-filled, fluid-filled, or solid (7cm deep)
Detect areas of tenderness
What type of sound would you hear when percussing over air areas (lungs)?
Resonant
What type of sound would you hear when percussing over solid areas (liver)?
Dull
What type of sound would you hear when percussing over fluid-filled areas (bone/muscle)?
Flat
What type of sound would you hear when percussing over hollow areas (stomach)?
Tympani
What type of lung issue would produce a hyper-resonant tone, very loud intensity, low pitch, and long duration?
COPD or pneumothorax
What type of lung issue would produce a resonant tone, loud intensity, low pitch, and long
duration?
Chronic bronchitis
What type of lung issue would produce a tympanic tone, loud intensity, high pitch, and moderate
duration?
Large pneumothorax
What type of lung issue would produce a dull tone, medium intensity, moderate pitch, and moderate
duration?
Pneumonia or pleural effusion
What type of lung issue would produce a flat tone, soft intensity, high pitch, and short duration?
Pleural effusion
What is the purpose of auscultation?
Determine whether there is normal air-flow, airway
obstruction, or abnormal air or fluid within the chest or
lungs
What location of breath sounds has equal inspiration and expiration durations, a very loud intensity, and high
pitch?
Tracheal
What location of breath sounds has expiration longer than inspiration?
Bronchial (over manubrium)
What location of breath sounds has equal inspiration and expiration durations, a moderate intensity, and moderate pitch?
Broncho-vascular
Ant: 1st & 2nd interspaces
Post: interscapular
What location of breath sounds has inspiration longer than expiration?
Vesicular (most of peripheral lung)
Patient says “99” during auscultation and you are listening for a louder sound. What test is this?
Bronchophony
Patient says “EE” during auscultation and you are listening for an “AAY” sound. What test is this?
Egophony
What is it called when sounds are superimposed on usual breath sounds?
Adventitious
Ex: Crackles, rhonchi, wheezes
During auscultation you hear intermittent, nonmusical, brief, velcro-like sounds. What is this called?
Crackles
During auscultation you hear intermittent, nonmusical, brief, velcro-like sounds. They are soft, high pitched and very brief. What is this called?
Fine crackles
During auscultation you hear intermittent, nonmusical, brief, velcro-like sounds. They are louder, lower pitched and brief. What is this called?
Coarse crackles
During auscultation you hear musical low pitched, snoring wheeze that clears with cough. What is this called?
Rhonchi
During auscultation you hear high pitched, hissing, shrill, whistling. What is this called?
Wheeze
What is stridor?
Inspiratory wheeze (larynx/tracheal obstruction)
Crackle sounds are indicative of what?
Bronchitis, pulmonary fibrosis, CHF
Ronchi sounds are indicative of what?
Large airway secretions, chronic bronchitis
Wheeze sounds are indicative of what?
Asthma, COPD, chronic bronchitis, bronchus obstruction
What does pleural friction rub sound like and what causes it?
Crackle-like creaking sounds from inflamed pleural surfaces rubbing together.
Recent URI, pneuomia
What does mediastinal crunch (hamman’s sign) sound like and what causes it?
Precordial crackles in sync with heartbeat, not respiration
Mediastinal emphysema
At what level of the ribs should you place your thumbs to test respiratory expansion?
10th ribs
What are palpable vibrations transmitted through bronchiopulmonary tree to chest wall with patient verbalization?
Fremitus
What is fluid collection within the chest but outside
the lung, causing lung compression?
Pleural effusion
What is air collection within the chest but outside the
lung, causing lung compression?
Pneumothorax
What is overdistention of distal airspaces, resulting in limited expiratory flow
and lung hyperinflation?
COPD
Chronic Obstructive Pulmonary Disease
What is alveoli filled with fluid/blood/pus increasing the density and opacity of the lung tissue?
Consolidation/infiltrate
Patient presents with dull percussion, bronchial and crackle breath sounds, increased transmitted voice sounds, and increased tactile fremitus. What do you suspect?
Consolidation- Pneumonia
Patient presents with dull to flat percussion, decreased breath sounds, decreased transmitted voice sounds, and decreased tactile fremitus. What do you suspect?
Pleural effusion
Patient presents with hyperresonant or tympanic percussion, decreased breath sounds, decreased transmitted voice sounds, and decreased tactile fremitus. What do you suspect?
Pneumothorax
Patient presents with diffusely hyperresonant percussion, decreased breath sounds, decreased transmitted voice sounds, and decreased tactile fremitus, and increaed AP diameter of chest. What do you suspect?
COPD
Patient presents with resonant percussion, obscured breath sounds due to high pitched wheezes, decreased transmitted voice sounds, and decreased tactile fremitus. What do you suspect?
Asthma
Patient presents with resonant percussion, vesicular breath sounds with some crackles, wheezes or rhonchi, normal transmitted voice sounds, and normal tactile fremitus. What do you suspect?
Chronic bronchitis
What is the sternal angle or angle of Louis?
The bony ridge that joins the manubrium and sternal body
Are the intercostal spaces above or below their correspondent ribs?
Below
